Attachment I – Partner Declaration
The purpose of this declaration is to determine whether a prospective partner is committed to UNICEF values and principles.Information provided in this form will be used to inform the review and evaluation of CSO submissions as outlined in the Call for Expression of Interest under section 3.
Partner Declaration
Name of organisation: ______
Partner / Yes / No
By answering yes, the organization confirms that neither the organisation nor any of its members is mentioned on any of the United Nations Security Council targeted sanctions lists
By answering yes, the organization confirms that it is committed to the core values of the UN, the Convention on the Rights of the Child (CRC), the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and the Convention on the Rights of Persons with Disabilities (CRPD).
Does the organisation have an Annual Report that is publicly available?
Attach the latest report or provide URL
Does the organisation have an annual audit of financial statements?
Attach the latest report or provide URL
I declare, as an official representative of the above-named organization, that the information provided in this declaration and Call for Expression of Interest is complete and accurate, and I understand that it is subject to UNICEF verification.
SignatureName and title of the duly authorized partner representative
Name of the partner
Date
Attachment II – CSO Identification Profile
The purpose of this profile is to provide key contact references to UNICEF Lebanon on the CSO’s mandate, field of work, technical and managerial capacities and comparative advantage in relation to the proposed programme(s).Information provided in this form will be used to inform the review and evaluation of CSO submissions as outlined in the Call for Expression of Interest under section 3.
Section 1. CSO information
1.1 Organization information / Organization Name
Acronym
Category of CSO[1]
Address
Registration number / (copy of registration to be attached)
Telephone
Website
1.2 Head of Organisation / Name, Surname
Function
Telephone
1.3 Contact person (if different from 1.2) / Name, Surname
Function
Telephone
1.4 Programme Proposal title(s) submitted with Application
Section 2. CSO expertise and experience in the sector area
2.1 CSO mandate, sector area and geographic coverage / Outline the organisation’s mandate, field of work and geographic coverage
2.2 Available expertise and specialists / Outline the distinctive technical capacity of the organisation in the sector area
2.3 Key results achieved over the past 5 years / Outline of key results achieved in sector area in recent years, including any recognition received at local / global level for the work in the sector area
Section 3. Local experience, presence and community relations
3.1 Ongoing programmes in sector area / Outline of type / scope of ongoing programmes in the sector area
3.2 Knowledge of the local context / Outline of presence and community relations in the proposed programme location(s)
3.3 Existing networks / Outline of ongoing collaborations with national institutions and local communities in the sector area
Section 4. Management Ability
4.1 Annual budget / Size of annual budget (previous year, USD)
Source of core funds or income
Main funding partners/ donors
4.2 Core staff / Outline of number and key functions of core organisation staff
4.3 Any other information
demonstrating financial capacity / E.g. results of previous capacity assessments if available (such as the micro assessment)
Section 5. Experience of working with UN/ UNICEF
Programme/project title / Total budget (USD) / Funding UN agency / Year end / Key results achieved
1.
2.
3.
Attachment III - Programme Proposal
The purpose of this proposal is to provide an outline of the proposed intervention for which the CSO is proposing to partner with UNICEF.Information provided in this form will be used to inform the review and evaluation of proposals as outlined in the Call for Expression of Interest under Section 3.
Section 1. Proposal overview
1.1 Programme title
1.2 Sector to which the programme contributes / Clearly state whether your programme will focus on services in the area of:
a)Child Protection
b)Gender-Based Violence
c)Both Child Protection and Gender-Based Violence
1.3Outputs to which the programme contributes / Refer to Section 1.3 of the Call for Expression of Interest
1.4 Programme duration / Number of months, From MM/YYYY to MM/YYYY
1.5 Geographical coverage / State/ province, etc.
1.6Population focus for each of the services and unit costs / List here the services (among those listed in the “Scope of services” document) you will implement, indicating the number of people reached under each of them and the unit cost (inclusive of running and staffing costs, pro-rated “effective and efficient programme management” costs and pro-rated 7% -when applicable).
CP and GBV services are to be listed separately.
E.g.:
- Case management: # children at #$ unit cost (total cost: #$)
- Etc.
1.7 Programme Budget / From CSO / %
From UNICEF (cash+supplies) / %
Total
Section 2. Programme description
2.1 Rationale/ justification
(3 to 5 paragraphs; max 400 words) / “Why” this programme
This section outlines the problem statement, the context and the rationale for the Programme,:
- Overview of the existing problem, using data (disaggregated) from existing reports; who is affected and what are the barriers/bottlenecks to outcomes for children?
- How the problem is linked to national priorities and policies;
- The relevance of the Programme in addressing problem identified.
2.2 Expected results
(3 to 5 paragraphs; max 400 words) / “What” this programme will achieve and “how” (applicants covering CP and GBV will be required to highlight results separately as much as possible)
2.3 Gender, Equity and Sustainability
(3 paragraphs; max 250 words) / “How” this programme takes into account gender, equity and sustainability
This section briefly mentions the practical measures taken in the programme to address gender, equity and sustainability considerations.
2.4 Partner’s contribution
(1 paragraph; max 100 words) / This section briefly outlines the partner specific contribution to the programme (monetary or in-kind)
2.5 Other partners involved
(1 paragraph; max 100 words) / “With whom” will this programme works in partnership
This section outlines other partners who have a role in programme implementation, including other organisation providing technical and financial support for the programme.
2.6 Additional documentation
(1 paragraph; max 100 words) / Additional documentation can be mentioned here for reference.
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Section 3. Programme work plan and budgetThe table below defines the programme implementation work plan (the specific activities to be undertaken towards achievement of each of the programme outputs; the schedule of implementation; and the planned budget, including the CSO and UNICEF’s contributions to the programme). CP and GBV activities (for applicants proposing both) will have to be displayed under separate sections.
NB. A separate section of the work plan should be created for each of the applicable AWP 2018 indicators listed here below (in line with the services listed in the “Scope of services” annex)
Applicable 2018 AWP Outputs and indicators:
Output 2: Boys, girls and women at risk or survivors of violence have access to an integrated package of quality prevention and response services in most disadvantaged localities in Lebanon.
Indicators:
Child Protection
# of girls and boys receiving specialized/focused PSS
# of boys and girls assisted through child protection case management and specialized services
Gender-Based Violence
# women and girls accessing mobile and safe spaces
# of institutional actors trained who demonstrate increased knowledge of SGBV
Output 3: Children, families and communities in most disadvantaged localities have increased capacities to promote practices that protect them
Indicators:
Child Protection
# of girls and boys participating in community based child protection activities
# of caregivers engaged in activities to promote wellbeing and protection of children
Applicable to both Child Protection and Gender-Based Violence
# of communities actively engaged in child protection/GBV activities
# of mothers, fathers, community members, boys and girls engaged in awareness, sensitization and social mobilization interventions on child protection, justice for children and gender-based violence
Result Level / Activity / Timeframe (quarters/year(s) / Total(CSO+UNICEF) / CSO contribution / UNICEF contributionQ1 / Q2 / Q3 / Q4 / Cash[2] / Supply
AWP 2018
Output 2: / Example CP
Boys, girls and women at risk or survivors of violence have access to an integrated package of quality prevention and response services in most disadvantaged localities in Lebanon
# of girls and boys receiving specialized/focused PSS / Sub-total / Sub-total / Sub-total / Sub-total
Act.1.1 / Activity statement / x / x
Act. 1.2 / x / x / x
Act. 1.3 / x / x
Act. 1.4 / x / x / x / x
AWP 2018
Output 2: / Example GBV
Boys, girls and women at risk or survivors of violence have access to an integrated package of quality prevention and response services in most disadvantaged localities in Lebanon
# women and girls accessing mobile and safe spaces / Sub-total / Sub-total / Sub-total / Sub-total
Activity statement
AWP 2018
Output3: / Example CP
Children, families and communities in most disadvantaged localities have increased capacities to promote practices that protect them
# of caregivers engaged in activities to promote wellbeing and protection of children / Sub-total / Sub-total / Sub-total / Sub-total
Act 2.1 / Activity statement[3]
Act. 2.2
Sub-total for the outputs
Progr. Output N / Effective and efficient programme management / Sub-total output N / Sub-total output N / Sub-total output N / Sub-total output N
ActN.1 / Standard activity: In-country management & support staff[4] pro-rated to their contribution to the programme (representation, planning, coordination, logistics, admin, finance)
ActN.2 / Standard activity: Operational costs pro-rated to their contribution to the programme (office space, equipment, office supplies, maintenance)
ActN.3 / Standard activity: Planning, monitoring, evaluation and communication[5], pro-rated to their contribution to the programme (venue, travels, etc.)
Sub-total for programme costs
HQcosts[6] / HQ technical support[7](7% of the cash component – only for International CSOs)
Total programme document budget
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Please indicate your targets disaggregation per governorate
Indicator / Total / Akkar / North / Baalbeck and Hermel / Bekaa / Beirut / Mount Lebanon / Nabatiyeh / SouthChild Protection
# of girls and boys receiving specialized/focused PSS
# of boys and girls assisted through child protection case management and specialized services
# of girls and boys participating in community based child protection activities
# of caregivers engaged in activities to promote wellbeing and protection of children
# of communities actively engaged in child protection/GBV activities (CP-specific targets)
# of mothers, fathers, community members, boys and girls engaged in awareness, sensitization and social mobilization interventions on child protection, justice for children and gender-based violence (CP-specific targets)
Gender-Based Violence
# women and girls accessing mobile and safe spaces
# of institutional actors trained who demonstrate increased knowledge of SGBV
# of communities actively engaged in child protection/GBV activities (GBV-specific targets)
# of mothers, fathers, community members, boys and girls engaged in awareness, sensitization and social mobilization interventions on child protection, justice for children and gender-based violence (GBV-specific targets)
1
[1] Choose between: National NGO (NGO); International NGO (INGO); Academic Institution; Community Based Organisation (CBO);Foundation; Other (please specify).
[2]The budget is prepared in the currency of implementation. Most generally, this correspond to the local currency in the country.
[3] Costs budgeted as part of the programme output budgeting include the following:
- Cash for activities, such as workshop or trainings;
- Cost of supplies that directly assist beneficiaries or beneficiaries institutions, including warehousing, transport and assembling;
- Technical assistanceand costs of technical staff to directly support beneficiaries / beneficiary institutions (experts in health, education, protection, etc.);
- Cost of surveys and other data collection activities in relation to beneficiaries or measurement or programme expected results;
- Communication activities to directly support programme planned results.
[4] Costs of technical assistance/staff directly related to the achievement of planned results are budgeted as part of programme output budgeting, see above footnote 4.
[5] Costs of M&E and communication activities directly related to the achievement of the planned results re budgeted as part of the programme output budgeting, see above footnote 4.
[6] Only payable to organizations with headquarters outside of the country of implementation.
[7] Amount is an estimate. Amount paidis a standard 7% on actual expenditures subject to calculation exclusions as per Annex I of the CSO Procedure.